Laparoscopic Cystotomy Research Articles

Partial Cystectomy for Deeply Infiltrating Endometriosis of the Bladder with Cystotomy Repair

Video Objective To demonstrate safe surgical technique and management of partial bladder cystectomy and simple cystotomy repair due to deeply infiltrating endometriosis (DIE) using the Xi DaVinci robot. Setting A 32yo patient with dysmenorrhea and dyspareunia found to have DIE of the bladder undergoing surgical management at a large academic center. Interventions The bladder lesion was initially found on preoperative MRI and confirmed during robotic assisted surgery. The lesion was felt to be full thickness and required partial bladder cystectomy for adequate excision of the implant. The DaVinci robot was used to remove the lesion with good margins. The resulting cystotomy repair was repaired, with good seal noted when the bladder was backfilled and on cystoscopy. A foley catheter was maintained for 7 days postoperatively and removed after a cystogram showing adequate bladder recovery. Conclusion Deeply infiltrating endometriosis of the bladder is rare but can be safely managed with laparoscopic partial bladder cystectomy and cystotomy repair. Adequate preoperative planning and thorough inspection of the lesion during surgery can assist with full removal of the lesion, which improves patient symptoms and decreases incidence of recurrence.

Teaching Cystotomy Repair: Low Fidelity Model Provides Effective Simulation at Minimal Cost

PURPOSE: To develop an inexpensive bladder model that can be used to teach Ob-Gyn Residents open and laparoscopic cystotomy repair. BACKGROUND: Recognition of cystotomy and repair is a requirement of Ob-Gyn surgical milestones. Simulation products currently exist for cystoscopy but not for cystotomy repair. METHODS: Pilot study of a novel low fidelity bladder model that can be used for simulation of both open and laparoscopic cystotomy repair. A cystotomy model was created using the following materials: small whoopee cushion “bladder mucosa”, shelf liner “bladder muscularis” and Press'n Seal® for “serosa.” Markings were placed inside the cushion to represent the trigone with ureteral orifices. Residents were asked to identify the model’s anatomic landmarks and rate their confidence in identifying cystotomy and performing both and open and laparoscopic cystotomy repair, pre- and post-simulation. RESULTS: 16 bladder models were constructed for approximately $1.50 per model. The model is reusable and manipulated well with surgical instruments and suture both open and laparoscopically; the model was a bit large for the laparoscopic trainer and lighting became a challenge for suturing. All participating residents correctly identified the anatomic structures post-simulation compared to 12/13 pre-simulation. Change in mean resident confidence was statistically significant for identifying cystotomy (pre M=3.1/5 vs. post M=4.2/5, P=.009) and performing open cystotomy repair (pre M=2.4/5 vs. post M=4/5, P=.03) but not for laparoscopic repair (pre M=1.6/5 vs. post M 3.1/5, P=.09). DISCUSSION: Our bladder model is easily constructed and inexpensive. It performs well for open cystotomy repair but has been decreased in size to better perform laparoscopically.

Ovarian reserve in patients who have undergone endometriosis surgery

Background/Aim. Endometriosis is a gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. The aim of this paper was to determine the effect of laparoscopic cystotomy and cystectomy on ovarian function, as well as to compare these two methods in terms of qualitative and quantitative damage to the ovaries, achieved pregnancies and recurrence. Methods. The prospective study, conducted in ?Narodni Front? Obstetrics and Gynaecology Clinic in Belgrade at the Endoscopic Infertility Treatment Ward, included a total of 150 patients. The study group was represented by 100 patients who underwent a surgical treatment of endometrial ovarian cysts. The patients in the study group were divided into 2 subgroups: Subgroup I consisted of 50 patients who underwent a laparoscopic cystotomy (incision of the cyst and thermal coagulation) and subgroup II which included 50 women who underwent a laparoscopic cystectomy. The control group consised of patients who underwent a surgery due to tubal factor infertility. The following parameters of the ovarian function were tested: the ovarian volume, the antral follicle count, the presence of the preovulatory follicle on the operated ovary, the serum levels of anti- M?llerian hormone (AMH), follicle-stimulating hormone (FSH), ovarian tumor marker (Ca 125), inhibin B, as well as the rate of achieved pregnancies one year after the surgery. Results. The ovarian volume and the antral follicle count as well as the FSH values were significantly higher in the control group in comparison with the patients in the study group. There were no significant differences in the ovarian volume, the antral follicle count, the AMH values and inhibin B values in the study group between the patients with cystectomy and those with the incision and coagulation of the cyst. Conclusion. Both surgical techniques diminished the ovarian reserve: cystectomy was more aggressive method in terms of the damage inflicted on the ovarian tissue, and incision with coagulation carried a higher risk of recurrence.

Laparoscopic cystostomy in pigs: Technique and comparison with traditional open cystostomy for surgical stress

Cystostomy is a common procedure in veterinary surgery. We describe a technique for laparoscopic cystostomy (LC group; n = 7) in Bama miniature pigs and compare the surgical stress induced by this procedure to open cystostomy (OC group; n = 7). A three-portal approach was used for laparoscopic cystostomy. First, we placed 2 simple interrupted sutures between the ventral body wall and urinary bladder. Then, a purse-string suture was placed in the urinary bladder wall, approximately 1 cm cranially to the two sutures. A stab incision was made at the center of the purse-string suture and a 12-F Foley catheter advanced into the urinary bladder; the suture was then pulled tightly and tied. Again, two interrupted sutures were placed 1 cm cranially to the catheter, between the ventral body wall and the bladder, to establish cystopexy. The extracorporeal portion of the catheter was fixed to the skin by a finger-trap suture. Blood samples were collected to measure the white blood cell count and serum concentrations of cortisol, interleukin-6, and C-reactive protein; follow-up laparoscopy was performed 1 month after the surgery. Laparoscopic cystotomy was successfully performed in all the pigs; the mean operating time was 43 ± 5 min. The levels of the stress markers reflected a lower stress response for LC than OC. Thus, LC appears to be better than OC both in terms of technique and physiological responses elicited, and may be more suitable than OC in the creation of experimental animal models for investigations on urinary diseases and those requiring diversion of urine flow.

Laparoscopic Management for Hydatid Disease of Liver: Experience of Single Center

Objectives: The objectives of this study were to investigate the characteristics and outcome of patients with hydatid disease of the liver who were laparoscopically managed at our clinic and to define technical details of the method. Materials and methods: Between January 2011 and June 2012, 11 patients with hydatid disease of the liver were considered for laparoscopic surgery in our department. All the patients underwent to laparoscopic surgical interventions. Results: In all patients, laparoscopic cystotomy, unroofing with laparoscopic cutting and sealing instruments for surgical dissection and omentoplasty were performed. No conversion to laparotomy was necessary. No radiological recurrens was observed in a mean follow-up of 11 months (range: 3-18 months). Conclusion: Laparoscopy is quite feasible to perform in hydatid disease of the liver and, the use of laparoscopic cutting and sealing instruments allows effective dissection and partial cystectomy. Cyst size and grade is not restrict laparoscopic surgery for liver hydatic disease. Obliteration of the residual cystic cavity decreases postoperative complication rates, so an effective omentoplasty is essential especially for laparoscopic procedures. The use of helical fasteners allows effective omental flap fixation.

Management of Laparoscopic Bladder Injuries

Injuries to the urinary system have been reported in up to 8% of minimally invasive gynecologic surgeries. Intraoperative recognition of a bladder injury allows for immediate repair and decreased postoperative morbidity rates. Although laparoscopic repair of such injuries requires advanced surgical skills, it affords the patient the benefits of minimally invasive surgery. In addition, laparoscopic visualization of the intravesical anatomy may help to delineate the relationship of the ureters to the bladder injury, thus avoiding further complication. This article will review the techniques and devices used to facilitate laparoscopic cystotomy repair.

Laparoscopic Cystotomy for Removal of a Large Bladder Polyp in a Juvenile Alpaca with Polypoid Cystitis

To describe a method for laparoscopic cystotomy in an alpaca. Case report. Female alpaca. An 8-month-old female alpaca was admitted with a 6-week history of straining to urinate and vulvar swelling. Transrectal ultrasound examination revealed a 1.5 x 1.5 x 2 cm polyp within the bladder. The mass was excised using laparoscopic cystotomy. Leakage from the cystotomy site resolved over 12 days using a Foley catheter. The alpaca was healthy and urinating normally at 9 months after surgery. Minimally invasive surgery by laparoscopic cystotomy can be used to remove large urinary polyps in alpacas. Urinary bladder polyps should be considered as differential diagnosis in alpacas with stranguria.

Laparoscopic Removal of an Intravesical Foreign Body After Laparoscopically Assisted Vaginal Hysterectomy

A foreign body in the bladder is a rare occurrence. Although most intravesical foreign bodies can be removed successfully using endoscopic transurethral extraction, suprapubic cystotomy may be required for the removal of large bodies. We report a case of an intravesical mass 8 cm in diameter that was successfully removed using laparoscopic cystotomy without further complications. The foreign body was a leiomyoma of the uterus that had not been removed during laparoscopically assisted vaginal hysterectomy. The myoma entered into the bladder through a defect that was not diagnosed nor repaired until after the vaginal extraction portion of the laparoscopically assisted vaginal hysterectomy. Laparoscopic removal of intravesical foreign bodies is desirable because it can shorten the duration of postoperative recovery, decrease morbidity, and reduce the incidence of postoperative complications. Laparoscopy is a useful modality for resolving complications within the urinary bladder.

Laparoscopic cystotomy for urolith removal in dogs: three case reports

The use of laparoscopic surgery for the removal of cystic calculi in three dogs was reported. Three trocars were used, one in the ventral midline (10mm) and the others in the right (10mm) and left (5mm) flanks. The calculi were removed and the bladder was sutured with intracorporeal technique in two layers, a simple continuous pattern and interrupted or continuous Lembert pattern. No postoperative complications were observed. One patient had a recurrence of urolithiasis, attributed to inadequate conservative treatment and to the lack of an appropriate diet. It was submitted to another similar videolaparoscopic cystotomy without complication. The proposed technique is appropriate and an alternative to conventional cystotomy for treatment of canine vesical urolithiasis.

Comparison of Healing after Cystotomy and Repair with Fibrin Glue and Sutured Closure in the Porcine Model

We compared healing after laparoscopic cystotomy using fibrin glue, sutures, or a combination to determine whether fibrin glue can obviate the need for sutures and whether there is any detriment when glue is used in the presence of sutures. In 24 Yorkshire pigs, a 3.5 cm vertical cystotomy was created laparoscopically and repaired as follows: Group 1--no closure; group 2--fibrin glue closure; group 3--suture repair; group 4--combined fibrin glue and suture repair. All animals had a Foley catheter for 1 week. In each group, three animals were harvested at 1 week (acute) and three animals were harvested at 6 weeks (chronic). Acute: Group 1--all pigs had an unhealed defect that leaked when evaluated by cystography. Groups 2, 3, 4--mean leak pressures were 80, 97, and 60 cm H(2)O (P = 0.36), respectively. Mean bladder capacity was not significantly different between groups. Chronic: No leakage seen on a cystogram at 1 week; at 6 weeks, bladders were filled at > or =95 to 100 cm H(2)O without leakage. Histologically, there was more inflammation in the acute group v chronic group pigs. In the acute group pigs repaired with glue or suture + glue, there was more inflammation and less epithelial continuity than in the suture alone group. At 6 weeks, there was no difference between groups. Fibrin glue provoked an intense inflammatory response that might have delayed healing acutely, resulting in a lower burst pressure in both scenarios in which it was used (i.e., alone or in combination with sutures). However, by 6 weeks, there did not seem to be any difference between groups either clinically or histopathologically.

Vesicovaginal Fistula with Secondary Vaginal Stones

We report a rare case of a vesicovaginal fistula associated with secondary vaginal stones that was managed totally endoscopically. A 52-year-old woman presented with urinary incontinence and perineal pain. On subsequent evaluation, we found a vesicovaginal fistula associated with secondary vaginal stones caused by a retained gauze. Management involved vaginoscopy, intracorporeal shock wave lithotripsy for vaginal stones, and removing retained medical gauze. We performed cystoscopy, laparoscopic cystotomy, transabdominal Foley catheterization of the vesicovaginal fistula for traction, injection of diluted adrenaline-saline solution for better dissection, dissection of the bladder from the vagina, tension-free closure of the bladder and vaginal defects, and closure of the cystotomy. Operative time was 155 minutes and blood loss was 60 mL. The patient was discharged on postoperative day 3, and catheterization time was 14 days. At 3-month follow-up, the patient was fully continent. To our knowledge, this is the first reported case of a vesicovaginal fistula associated with secondary vaginal stones which was managed totally endoscopically. We believe that this is a feasible and efficacious approach for the management of such cases.

LAPAROSCOPIC REPAIR OF VESICOVAGINAL FISTULA

Vesicovaginal fistula may be a complication of urogynecologic surgery. We describe the technique of laparoscopic repair of vesicovaginal fistula as performed at our 2 institutions. Since August 1998 laparoscopic repair of vesicovaginal fistula was performed in 15 select patients who had clear indications to undergo surgical treatment through an abdominal approach. Hysterectomy had previously been performed in 14 patients (93%). Conservative treatment was initially attempted for more than 2 months in all cases. Four patients had undergone a previous surgical fistula closure attempt with unsuccessful results. Our technique involved cystoscopy, catheterization of the vesicovaginal fistula, laparoscopic cystotomy, opening and excision of the fistulous tract, dissection of the bladder from the vagina, cystotomy closure and colpotomy with interposition of a flap of healthy tissue. Demographic as well as perioperative and outcome data were recorded. Average patient age was 38 years. None of the cases required open conversion. Mean operative time was 170 minutes (range 140 to 240). Mean hospital stay was 3 days (range 2 to 5). The mean duration of bladder catheterization was 10.4 days (range 9 to 15) At a mean followup of 26.2 months (range 3 to 60) 14 patients (93%) were cured. We believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity.

A new instrument, the "Perfore-Aspirator" for laparoscopic treatment of hydatid cysts of the liver.

The authors introduce a new instrument functioning as both perforator and aspirator in the laparoscopic management of hepatic hydatid cysts. Between January 1998 and January 2002, 11 laparoscopic cystotomy + partial cystectomy + drainage procedures were performed for eight consecutive patients. Eight of the cysts were located in the right lobe, and the remaining three in the left. The average diameter (+/-SD) of the cysts was 9.6 +/- 3.66 cm, and the mean age of the patients was 31.3 +/- 7.24 years. The diagnosis was confirmed by ultrasonography and/or computerized tomography. The procedure was performed with the help of three ports. The "perfore-aspirator" instrument (Bahadir Tibbi Aletler A. S., Samsun, Turkey) was introduced through the 10-mm trocar at the subcostal area, and the cystotomy procedure was done with success. Then, a partial cystectomy procedure was performed with the use of a grasper and scissors attached to an electrocautery device. The average hospitalization period was 5 +/- 1.69 days. No major morbidity or mortality was seen. All patients were treated with albendazole preoperatively and postoperatively.

Dorsally Recumbent Urinary Endoscopic Surgery

Laparoscopic cystotomy is the method of choice for treatment of a cystic calculus in the horse. The main advantage of this procedure over others is the excellent ability to view and gain operative access to the urinary bladder. This article describes the procedure, including techniques, instrumentation, preoperative and postoperative care, and complications.

Laparoscopic repair of bladder injury and laceration

The management of bladder injuries at laparoscopy is controversial. Some endoscopists believe in mandatory open repair, whereas others recommend laparoscopic cystotomy repair. We performed laparoscopy to treat two women with bladder injury, one with excision of a transmural nodule of bladder endometriosis, and the other with incidental cystotomy during adenexectomy in the presence of obliterative adhesions. After localizing the injury to the dome of the bladder remote from ureters, the edges of the injury were cleaned of damaged tissue and apposed in two layers using interrupted 4-0 polydioxanone endocorporeal sutures. The patients had an uneventful postoperative course, and neither experienced bladder function problems. We conclude that applying the already established tenets of bladder injury repair by laparotomy to laparoscopic procedures is acceptable in most endoscopic settings.